Hemangioma: A-to-Z Guide from Diagnosis to Treatment to Prevention

Introduction to hemangioma:

“I didn’t notice that little birthmark before… “It’s cute.” “It’s huge! Will it really go away?” Parents’ reactions to these colorful birthmarks vary almost as much as the hemangiomas themselves.

What is it?

Hemangiomas are tufts of extra blood vessels that commonly occur in children.

Usually, they occur on the surface of the skin (strawberry hemangiomas). Those that are deeper in the skin are sometimes called cavernous hemangiomas. Some are mixed strawberry and cavernous hemangiomas.

Most children with hemangiomas have only one. Many have a few. Rarely, children may have many, both on the skin and in the internal organs. Some have enough extravascular tissue to cause anemia or platelet problems.

Who gets it?

Hemangiomas are found on at least one in fifty babies. They tend to run in families. Girls are more likely to have hemangiomas than boys. They are also more common in babies with lighter skin coloring.

What are the symptoms?

Strawberry hemangiomas are bright red (or purple), soft, raised, squishy birthmarks with sharp borders. They often start as little red dots surrounded by a pale halo before they grow. They are most common on the head, chest, or upper back.

Deeper cavernous hemangiomas often appear bluish, and the borders look less distinct. If the hemangioma is deep enough, the overlying skin might look normal. Most are found on the head or neck.

Most hemangiomas grow rapidly, doubling their size, and then plateau for a while before collapsing and disappearing. When the color becomes dull, or the center appears gray or pinkish-gray, the hemangioma may be entering the slow disappearing phase.

Is it contagious?

No.

How long does it last?

Strawberry hemangiomas are usually not present at birth. Most appear between 3 and 5 weeks, and then grow quickly during the first six months. By the first birthday, most have already peaked in size. Many are gone by age two or three. Most are gone by school age. The great majority are gone without a trace before puberty.

Cavernous hemangiomas are more likely to be present at birth. They do not grow or disappear as rapidly. Still, more than ninety percent are gone by puberty.

In general, the size of the hemangioma and the location on the body does not correlate well with how completely it will disappear, although lip hemangiomas seem to be less likely to disappear completely.

How is it diagnosed?

Hemangiomas are usually diagnosed based on the physical exam. Sometimes blood tests or imaging studies are needed to assess the situation.

How is it treated?

The great majority of hemangiomas will disappear on their own (unlike port wine stains) and require no treatment.

However, treatment may be warranted when a hemangioma interferes with vision or feeding, when it involves vital internal organs, when it causes overlying ulcerations, or when it grows very rapidly.

When treatment is desired, there are several options available. Medicines, surgery, and laser therapy have all been used with success. There are some children’s hospitals where pediatric dermatologists and surgeons regularly work together to treat problematic hemangiomas.